If you smoke, used to smoke heavily, or are helping a parent who did, here is the short answer: Medicare covers an annual low-dose CT lung cancer screening, and the scan itself is $0. The part that trips people up is who counts as covered. You have to clear all five eligibility rules and complete a counseling visit before your first scan, or the free scan can turn into a bill.

In This Guide

Is Medicare's Lung Cancer Screening Really Free, and What Comes First?

Medicare Part B covers one lung cancer screening a year with a low-dose CT scan, usually shortened to LDCT. When your provider accepts assignment, you pay nothing for it: no Part B deductible, no coinsurance.

But there's a step that has to come first, and it catches people off guard. Before your first scan, Medicare requires a counseling and shared decision-making visit with your provider, and it has to be documented in your medical record. Here is what that visit covers:

  • Your provider confirms you meet the criteria.
  • You go through the decision together, using a decision aid.
  • You talk about why sticking with the screening every year matters and how your other health conditions factor in.
  • You talk about quitting smoking, or staying quit.

That visit is also $0 on assignment, and the rule names it as a step before your first scan, not before every annual one. Think of it as the appointment that unlocks the scan.

You also need an order from your provider. So this isn't a walk-in test. The order, plus the counseling visit the first time around, are the gates you pass through before the free scan.

Where the scan happens matters too. Medicare requires it at a radiology imaging facility that uses a standardized system for identifying, classifying and reporting lung nodules, with a board-certified or board-eligible radiologist reading it. When you schedule, ask the office to confirm the facility meets that standard.

Does Medicare Cover Your Lung Cancer Screening? The Five Rules

Here's where "covered" gets specific. To get the $0 screening, you have to meet all five of these, not just one or two. The rules come from Medicare.gov's lung cancer screening page and the national coverage determination (NCD 210.14):

  • You're between 50 and 77.
  • You have no signs or symptoms of lung cancer (the screening is meant for people who feel fine, which doctors call asymptomatic).
  • You have a tobacco smoking history of at least 20 pack-years.
  • You're a current smoker, or you quit within the last 15 years.
  • You have an order from your provider.

What's a pack-year? It's a way of measuring how much you've smoked over time. One pack-year means smoking an average of one pack (20 cigarettes) a day for a year, so 20 pack-years is a pack a day for 20 years, two packs a day for 10 years, and so on.

Miss any one of these and the $0 screening doesn't apply. A pack-a-day smoker who quit 16 years ago is just past the 15-year window; someone who's 78 is just past the age limit. Both may still worry about lung cancer, and both fall outside Medicare's screening rules. If that's you, the next section and the step list at the end cover what to do.

The Age Gap: Medicare Stops at 77, the Task Force Says 80

Medicare's rules create an age gap. The U.S. Preventive Services Task Force, the independent panel that grades preventive care, recommends annual lung cancer screening for adults aged 50 to 80. Medicare's coverage rule stops at 77.

So there's a real gap. If you're 78, 79, or 80, you meet the national recommendation to be screened, but you've aged out of Medicare's coverage band. That doesn't mean you can't be screened. It means Medicare's LDCT screening benefit won't cover it at $0 the way it would have a year or two earlier. If you're in that window and have a smoking history of 20 pack-years or more, it's worth a direct talk with your doctor about whether to screen. Being told you fall outside the coverage is stressful, so ask the practical question plainly: what would this scan cost me out of pocket? Medicare's screening benefit does not apply past 77, so the office can only tell you its own self-pay price.

When the Scan Finds Something to Follow Up On

The $0 covers screening, and only screening. If your scan turns up a nodule or spot that needs a closer look, what comes next is no longer the free preventive test. A follow-up diagnostic CT, a PET scan, or a biopsy is diagnostic care, not part of the screening benefit. The CDC says follow-up tests may carry a cost such as a copay or deductible. Under Original Medicare, most outpatient services carry the Part B deductible ($283 in 2026) and then 20% of the Medicare-approved amount, so ask the office what your follow-up would cost before you schedule it.,

Service What you pay (Original Medicare, 2026)
Counseling visit and annual screening LDCT $0 when your provider accepts assignment
Follow-up diagnostic CT, PET scan or biopsy May carry costs such as the Part B deductible ($283), then typically 20%

Waiting on a result is stressful enough without a billing surprise. That's not a reason to skip the screening, since catching something early is the whole point of it. It's just worth knowing that the $0 stops at the scan itself.

What to Do Next

  1. Call your doctor's office and ask to schedule a lung cancer screening counseling and shared decision-making visit.
  2. Ask whether the provider accepts assignment, since the $0 depends on it. A provider who doesn't accept assignment can charge more than the Medicare-approved amount.,
  3. If a provider thinks Medicare will deny a service, they should give you a written Advance Beneficiary Notice before the visit. It lets you choose whether to go ahead, and agreeing can make you responsible for the bill, so read it before you sign.
  4. If you're unsure whether something is covered, use Medicare.gov's coverage lookup at Medicare.gov/coverage or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
  5. If you have a Medicare Advantage plan, it must cover what Original Medicare covers, but it may use networks and prior authorization, so call the plan before booking.
  6. If you miss a rule, such as being 78 or older, Medicare's screening benefit doesn't apply. Ask the provider for the self-pay price before you decide.

Frequently Asked Questions

Is Medicare's lung cancer screening really free?

On assignment, yes, with no deductible and no coinsurance. The thing to watch isn't a hidden fee. The $0 is tied to a provider who accepts assignment, so confirm that first. And if the paperwork shows you missed one of the five rules or skipped the counseling visit, the scan doesn't qualify for this coverage, and the bill can land on you. So "free" hinges on getting the eligibility and the order right up front.

What's a pack-year, and how do I know if I have 20?

You don't have to nail the math yourself. Your provider confirms your eligibility at the counseling visit, and you can bring your smoking history to that conversation. If you want a rough gauge before you go in, 20 pack-years is about a pack a day for 20 years, so if your history is anywhere near that line, it's worth raising, even if you're unsure you clear it.

Why do I need a visit before my first scan?

Because Medicare makes it a condition of coverage, not optional paperwork: skip the shared decision-making visit and your first scan isn't covered. Practically, it's your chance to ask questions and weigh the decision with your provider before you commit, and to confirm your provider is placing the order the scan requires. If you're set on screening, treat it as the appointment that unlocks the $0, not a hurdle.

I'm 78 and a former heavy smoker. Can I still get screened?

You can talk to your doctor about it, but you're past Medicare's coverage age band, which runs to 77. The U.S. Preventive Services Task Force recommends screening through 80, so a reader in the 78-to-80 window meets the national recommendation while falling outside what Medicare's screening benefit covers at $0. Ask your doctor whether to screen and what the scan would cost out of pocket.

What happens to the cost if the scan finds something?

The free screening covers the scan itself. If it turns up something that needs a closer look, the follow-up, a diagnostic scan or a biopsy, is not part of the free screening. The CDC says follow-up tests may have a cost, such as a copay or deductible, and under Original Medicare most outpatient services carry the Part B deductible and then 20% coinsurance. Plan on that part not being $0.,

Learn More

MedicareMedicare Preventive Services: What You Get for FreeMedicare preventive services are mostly free: two wellness visits, screenings, and vaccines at $0, plus the billing trap that can turn free into a charge. MedicareMedicare Prostate Cancer Screening: What It Actually CostsMedicare covers annual prostate screening for men over 50, but only the PSA test is free. The digital rectal exam is billed, plus what follow-up costs. MedicareDoes Medicare Cover an AAA Screening?Medicare covers a free AAA screening ultrasound, once per lifetime, for at-risk people with a referral and a provider who accepts assignment. See who qualifies. MedicareMedicare Annual Wellness Visit: What the Free Yearly Visit CoversYour Medicare Annual Wellness Visit is $0, but it's not a physical, and one new symptom can turn it into a bill. What's covered, and how to keep it free. MedicareDoes Medicare Cover Smoking Cessation? Counseling and the DrugsYes. Part B covers up to 8 quit-smoking counseling sessions a year, $0 if your provider accepts assignment. Prescription quit drugs fall under Part D.

Find personalized help understanding whether a parent qualifies for a free lung cancer screening at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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